Determinants of long-term allograft function following steroid withdrawal in renal transplant recipients

We retrospectively measured changes in serum creatinine concentration as estimates of changes in renal function in 96 renal transplant recipients who were withdrawn from steroid therapy, maintained on cyclosporine and azathioprine, and followed for 1 to 5 years. Multivariate analyses were used to assess the influence of cyclosporine dose and blood levels, azathioprine dose, age, sex, race, diabetes, HLA match and mismatch, PRA, and history of rejection following steroid withdrawal on long-term allograft function. Results indicate that acute rejection and cyclosporine dose are the major factors influencing long-term renal function after steroid withdrawal. In this setting, there is an inverse relationship between cyclosporine dose and serum creatinine concentration for up to 5 years. Optimal renal function is achieved in patients receiving more than 5.5 mg/kg of cyclosporine per day at the time of steroid withdrawal.